dysrythmias report
TRANSCRIPT
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DYSRHYTHMIAS
an irregular or abnormal heart rate
occurs when the average adult heart rate fallsbelow or rises above the normal range of 60
to 100 beats per minute
Disorders of the formation and/or conduction
of electrical impulses in the heart
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Normal Cardiac Rhythm
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What are the symptoms?
Palpitations, which can be
skipping, fluttering or pounding
in the chest
Fatigue
Chest pressure or pain
Shortness of breath
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Fainting, also known assyncope, or near-syncope
Lightheadedness ordizziness
Cardiac Output
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Sinus Node Dysrhythmias
Sinus Bradycardia
Sinus Tachycardia Sinus Arrhythmia
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Junctional Dysrhythmias
Premature Junctional
Complex
Junctional Rhythm
Atrioventricular NodalReentry Tachycardia
Supraventricular tachycardia
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Ventricular Dysrhythmias
Premature Ventricular
Complex
Ventricular Tachycardia
Ventricular Fibrillation
Idioventricular Rhythm
Ventricular Asystole
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How are arrythmias
diagnosed?
Electrocardiogram
Holter monitor
Treadmill testingElectrophysiologic testing
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ECG Interpretation
P wave represents atrialdepolarization
QRS complex represents ventricular
depolarization T wave represents ventricular
repolarization
U wave may representrepolarization ofPurkinje fibers.May also be seen in hypokalemia,
hypertension, or heart disease
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PR interval normal range is 0.12-0.20seconds
ST segment is identified as isoelectric,or above or below isoelectric line
QT interval normal range is 0.32-0.40seconds
TP interval is isoelectric period
PP
interval signifies atrial rhythm andrate
RR interval signifies ventricular rateand rhythm
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Waves, Complexes, and
Intervals
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Nursing Interventions
Monitoring and
managing thedysrhythmia
Minimizing anxietyTeaching self-care
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Specific Nursing Managements
Provide continuous ECG monitoring.
Maintain heart rate alarms at appropriate
limits.
Administer anti-arrhythmic medications asordered.
Administer defibrillation or CPR as
appropriate for life threateningarrhythmias.
Monitor electrolyte levels and replace as
necessary.
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Maintain at least one patent IV site.
Monitor serum levels of antiarrhythmic medications.
Provide information to the patient
regarding disease process, proceduresand medications.
Teach patient regarding symptoms of
arrhythmias. Teach patient how to take own pulse
Teach patient to avoid proarrhythmic
substances.
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Anti-dysrhythmic Therapy
Class I: Sodium Channel Blockers IA: delay repolarization
IB: accelerate repolarization
Lidocaine (IV)
Enhances repolarization (no QT prolongation)
No anticholinergic effectsOnly works for ventricular dysrhythmias
Adverse effects
CNS toxicity: seizures, resp arrest
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Class II: Beta blockers
Propanolol
Acebutolol
Esmolol
SotalolAdverse effects
Heart failure, AV block, sinus arrest
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Class III: Potassium Channel
Blockers
Amiodarone (PO, IV)
First line for V-fib maintenance
Works against both atrial and
ventricular
Adverse: HR, lung damage, visual
impairment
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Class IV: Calcium Channel
Blockers
Only non-dihidopyridines
Verapamil & diltiazem
Slow SA node automaticity
Delay AV conduction
Reduction of myocardial contractility
HR, AV block, Heart failure,
hypotension, constipation
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Other Antidysrhythmics
Adenosine
Short half life, termination of paroxysmal SVT
Digoxin
Decreases conduction through AV node,
increases Vagal tone, decreases SAautomaticity
Ibutilide
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Pacemaker Therapy
Provides electrical stimuli to
heart muscle
Used for slower-than-normalimpulse formation, to control
some tachycardias, or for
advanced heart failure May be permanent or temporary
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Cardioversion and
DefibrillationDelivery of electrical current
to depolarize a critical mass ofmyocardial cells
When cells repolarize the SA
node, is usually able torecapture its role as
pacemaker of heart
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Cardioversion and
Defibrillation (contd) Cardioversion involves use of timed
electrical current to terminate atachydysrhythmia
Defibrillation is used in emergency
situations as treatment for
ventricular fibrillation and pulseless
VT
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